All prior authorization (PA) requests must be submitted by the service provider and include complete and accurate clinical documentation to support the medical necessity of the requested services.
Important Notice: Requests submitted with incomplete, insufficient, or missing documentation may be pended or denied until all required information is received.
In cases of service denial, termination, suspension, or reduction, notice will be provided in accordance with 9 A.A.C. 34.
The primary method for submitting PA requests is through the AHCCCS Online Provider Portal.
You can access the portal directly or find the link under the Plans/Providers menu on the AHCCCS website.
Follow these steps to ensure a smooth and complete PA submission process:
New users must register for an account through the AHCCCS Online Portal.
Log in and enter your PA request using the PA submission link within the AHCCCS Online Portal.
Upload all necessary clinical documentation identified in AHCCCS policy using the online attachment feature. Incomplete submissions may result in delays or denials.
Once submitted, a case number is automatically assigned to your submission and the request is placed in pending status for review by the PA team.
A confirmation letter is mailed to the provider acknowledging receipt and the pending status of the PA request.
After your request has been reviewed, a second confirmation letter is mailed indicating the authorization decision.
Providers can monitor the status of submitted PA requests and view messages from PA staff via the Prior Authorization Inquiry link—available online 24/7.
An urgent PA request, as defined in A.A.C. R9-34-306(B), applies when adhering to the standard processing timeframe could seriously jeopardize a Fee-for-Service (FFS) member’s life, health, or ability to attain, maintain, or regain maximum function.
Submission Steps for Urgent Requests
Enter the urgent PA request through the AHCCCS Online Provider Portal.
Immediately after submission, email the PA number to the Care Management (CM) team at Caremanagers@AZAHCCCS.gov to notify them of the urgent request.
Providers can verify the status of their urgent request within 24–72 hours of submission via the Provider Portal.
Important Notice: Urgent requests must include sufficient clinical detail to justify the urgency. Requests lacking this documentation will be processed under the standard PA timeframe.
While the AHCCCS Online Provider Portal remains the primary method for submitting prior authorization (PA) requests, fax submissions are permitted under limited circumstances for Fee-for-Service (FFS) providers:
The member is enrolled in the Tribal Arizona Long Term Care System (ALTCS) and the provider is requesting authorization for an acute service (e.g., inpatient hospital admission, surgery, behavioral health inpatient facility).
The provider is unable to submit via the Provider Portal due to an internet or electrical outage. The nature of the outage must be clearly documented in the fax submission.
The provider has requested AHCCCS Online login credentials, and the service requiring authorization is scheduled to occur within four weeks of the credential request date.
All faxed PA requests must include the following as the cover page:
Note: All required supporting clinical documentation must be attached behind the request form.
Faxed Authorization Status Verification:
Important Notice: Except for acute service requests for Tribal ALTCS members, fax submissions are a temporary accommodation. Providers are not permitted to use fax as a substitute for creating an AHCCCS Online Provider Portal or ID me account.
Requests that do not meet the criteria for faxed submission will not be processed and will be returned to the provider for resubmission via the AHCCCS Online Provider Portal.
| Request Type | Fax Number |
|---|---|
| Medical PA | 602-256-6591 |
| Utilization Review | 602-254-2304 |
| ALTCS | 602-254-2426 |
| Behavioral Health | 602-253-6695 |
| Non-Emergency Medical Transport | 602-254-2431 |
| Transplant | 602-256-4860 |
General Contact Information:
